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Interventions to Improve Adolescent HIV Care Outcomes. 改善青少年艾滋病毒护理结果的干预措施。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-08-01 Epub Date: 2023-06-10 DOI: 10.1007/s11904-023-00663-z
Marta I Mulawa, Elizabeth T Knippler, Maryam Al-Mujtaba, T Harper Wilkinson, Venkata K Ravi, Leila S Ledbetter

Purpose of review: This review of recent studies evaluating interventions to improve HIV care outcomes among adolescents with HIV (AHIV) was conducted to provide a comprehensive overview of the recent evidence, highlight promising approaches, and suggest directions for future research.

Recent findings: Our scoping review revealed 65 studies evaluating a variety of interventions and using a range of study designs at various stages of research. Effective approaches included community-based, integrated service delivery models with case management, trained community adolescent treatment supporters, and consideration of social determinants of health. Recent evidence also supports the feasibility, acceptability, and preliminary efficacy of other innovative approaches, including mental health interventions as well as technology-delivered approaches; however, more research is needed to build the evidence base for these interventions. Our review's findings suggest that interventions providing comprehensive, individualized support are essential to improving HIV care outcomes among adolescents. More research is needed to build the evidence base for such interventions and ensure effective, equitable implementation to support the global target of ending the AIDS epidemic by 2030.

综述的目的:对最近评估干预措施以改善艾滋病毒感染青少年(AHIV)艾滋病毒护理结果的研究进行综述,以全面概述最近的证据,强调有前景的方法,并为未来的研究提出方向。最近的发现:我们的范围审查显示,65项研究评估了各种干预措施,并在不同的研究阶段使用了一系列研究设计。有效的方法包括以社区为基础的、具有病例管理的综合服务提供模式、经过培训的社区青少年治疗支持者以及考虑健康的社会决定因素。最近的证据也支持其他创新方法的可行性、可接受性和初步疗效,包括心理健康干预措施以及技术提供的方法;然而,还需要更多的研究来为这些干预措施建立证据基础。我们的综述结果表明,提供全面、个性化支持的干预措施对于改善青少年艾滋病毒护理结果至关重要。需要进行更多的研究,为此类干预措施建立证据基础,并确保有效、公平地实施,以支持到2030年结束艾滋病流行的全球目标。
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引用次数: 0
Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections. 醋酸甲羟孕酮注射液对阴道黏膜终点的影响及与性传播感染的相关性的最新进展。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-08-01 Epub Date: 2023-06-21 DOI: 10.1007/s11904-023-00662-0
Smritee Dabee, Christina Balle, Maricianah Onono, Steve Innes, Gonasagrie Nair, Thesla Palanee-Phillips, Adam D Burgener, Steven E Bosinger, Jo-Ann S Passmore, Renee Heffron, Heather Jaspan, Anna-Ursula Happel

Purpose of review: The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial.

Recent findings: Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV.

审查目的:醋酸甲羟孕酮长效可逆肌肉注射避孕药(DMPA-IM)被非洲的顺性别妇女广泛使用。虽然 DMPA-IM 能提供可靠的避孕效果,但它对女性生殖道(FGT)粘膜的潜在影响,包括感染 HIV 的风险,引起了人们的关注。本综述总结并比较了观察性队列研究和随机 "艾滋病结果中的避孕选择证据(ECHO)试验 "的证据:尽管之前的观察性研究发现,使用 DMPA-IM 的妇女体内与细菌性阴道病(BV)相关的细菌数量较多、炎症加剧、宫颈阴道 HIV 靶细胞密度增加以及上皮屏障受损,但 ECHO 试验的子研究发现,除了 Th17 样细胞增加外,阴道微生物组、炎症、蛋白质组、转录组以及病毒性和细菌性 STI 风险均未发生不利变化。随机数据表明,使用 DMPA-IM 不会对与感染相关的粘膜终点产生不利影响。这些研究结果支持在感染性传播疾病(包括艾滋病毒)的高风险妇女中安全使用 DMPA-IM。
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引用次数: 0
Interventions to Reduce Alcohol Use and HIV Risk among Sexual and Gender Minority Populations: a Systematic Review. 减少性少数群体和性别少数群体中饮酒和 HIV 风险的干预措施:系统综述。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-08-01 Epub Date: 2023-05-25 DOI: 10.1007/s11904-023-00660-2
Carolyn Lauckner, Kimberly Haney, Fidelis Sesenu, Trace Kershaw

Purpose of review: Sexual and gender minority (SGM) individuals are diagnosed with HIV at disproportionate rates, and hazardous alcohol use can increase their HIV risk. This review assessed the state of the literature examining interventions for addressing alcohol use and sexual HIV risk behaviors among SGM individuals.

Recent findings: Fourteen manuscripts from 2012 to 2022 tested interventions that address both alcohol use and HIV risk behaviors among SGM populations, with only 7 randomized controlled trials (RCTs). Virtually all the interventions targeted men who have sex with men, with none focused on transgender populations or cisgender women. While they demonstrated some evidence of effectiveness in reducing alcohol use and/or sexual risk, the outcomes varied widely between studies. More research is needed that tests interventions in this area, particularly for transgender individuals. The use of larger-scale RCTs with diverse populations and standardized outcome measures are needed to strengthen the evidence base.

审查目的:性与性别少数群体(SGM)被诊断出感染 HIV 的比例过高,而酗酒会增加他们感染 HIV 的风险。本综述评估了针对 SGM 人饮酒和 HIV 性风险行为的干预措施的文献现状:从 2012 年到 2022 年,共有 14 篇手稿测试了针对 SGM 群体中饮酒和 HIV 风险行为的干预措施,其中只有 7 项随机对照试验 (RCT)。几乎所有干预措施都针对男男性行为者,没有一项针对变性人群或顺性女性。虽然这些干预措施在减少饮酒和/或性风险方面显示出一定的有效性,但不同研究的结果差异很大。我们需要更多的研究来检验这一领域的干预措施,尤其是针对变性人的干预措施。需要对不同人群进行更大规模的 RCT 研究,并采用标准化的结果测量方法,以加强证据基础。
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引用次数: 0
Ethical Perspectives in Using Technology-Enabled Research for Key HIV Populations in Rights-Constrained Settings. 在权利受限的环境中使用技术支持研究关键艾滋病毒人群的伦理观点。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00654-0
Lidia Flores, Sean D Young

Purpose of review: People who use illicit drug substances (e.g., heroin) and sex workers are vulnerable to acquiring HIV. Due to the criminalization of illicit drug substances and sex work in many countries, these populations often reside in rights-constrained settings where their well-being, freedom, and access to HIV prevention and care services may be compromised due to legal prosecutions and societal stigma.

Recent findings: This study conducted a literature review on papers that evaluated a combination of the following three components: ethics, technology-based research, and populations who use drug substances and/or sex workers. We explored research on these ethical perspectives from both key populations and researchers. Findings revealed potential risks in data security and possible harmful implications of compromised data within these rights-constrained settings. Best practices were explored within the literature to identify potential methods for addressing these ethical concerns and improving HIV prevention and care.

审查目的:使用非法药物(如海洛因)的人和性工作者容易感染艾滋病毒。由于许多国家将非法药物和性工作定为刑事犯罪,这些人群往往生活在权利受限的环境中,由于法律起诉和社会污名,他们的福祉、自由和获得艾滋病毒预防和护理服务的机会可能受到损害。最近的发现:本研究对评估以下三个组成部分的论文进行了文献综述:伦理、基于技术的研究、使用药物的人群和/或性工作者。我们从关键人群和研究人员的角度探讨了这些伦理观点的研究。调查结果揭示了数据安全方面的潜在风险,以及在这些权利受限的设置中受损数据可能产生的有害影响。在文献中探讨了最佳实践,以确定解决这些伦理问题和改善艾滋病毒预防和护理的潜在方法。
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引用次数: 0
The End Is in Sight: Current Strategies for the Elimination of HIV Vertical Transmission. 终点在望:消除艾滋病毒垂直传播的当前战略。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00655-z
Lanbo Yang, Mary Catherine Cambou, Karin Nielsen-Saines

Purpose of review: The goal of this review is to highlight and interpret recent trends and developments in the diagnosis, treatment, and prevention of HIV vertical transmission from a clinical perspective.

Recent findings: Universal third-trimester retesting and partner testing may better identify incident HIV among pregnant patients and result in early initiation of antiretroviral therapy to prevent vertical transmission. The proven safety and efficacy of integrase inhibitors such as dolutegravir may be particularly useful in suppressing viremia in pregnant persons who present late for ART treatment. Pre-exposure prophylaxis (PrEP) during pregnancy may play a role in preventing HIV acquisition; however, its role in preventing vertical transmission is difficult to elucidate. Substantial progress has been made in recent years to eliminate HIV perinatal transmission. Future research hinges upon a multipronged approach to improving HIV detection, risk-stratified treatment strategies, and prevention of primary HIV infection among pregnant persons.

综述目的:本综述的目的是从临床角度强调和解释HIV垂直传播的诊断、治疗和预防的最新趋势和发展。最近的发现:普遍的妊娠晚期再检测和伴侣检测可以更好地识别怀孕患者中的HIV事件,并导致早期开始抗逆转录病毒治疗以防止垂直传播。整合酶抑制剂(如多替格拉韦)已被证实的安全性和有效性可能对抑制抗逆转录病毒治疗晚期孕妇的病毒血症特别有用。妊娠期暴露前预防(PrEP)可能在预防艾滋病毒感染方面发挥作用;然而,它在防止垂直传播方面的作用很难阐明。近年来,在消除艾滋病毒围产期传播方面取得了实质性进展。未来的研究取决于多管齐下的方法来改善艾滋病毒检测、风险分层治疗策略和预防孕妇中的原发性艾滋病毒感染。
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引用次数: 0
The human microbiome and gut-liver axis in people living with HIV. 艾滋病毒感染者的人体微生物组和肠道-肝脏轴。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 Epub Date: 2023-05-02 DOI: 10.1007/s11904-023-00657-x
Maria J Duarte, Phyllis C Tien, Ma Somsouk, Jennifer C Price

Purpose of review: Chronic liver disease is a major cause of morbidity and mortality amongst people living with HIV (PLWH). Emerging data suggests that gut microbial translocation may play a role in driving and modulating liver disease, a bi-directional relationship termed the gut-liver axis. While it is recognized that PLWH have a high degree of dysbiosis and gut microbial translocation, little is known about the gut-liver axis in PLWH.

Recent findings: Recent studies have shown that microbial translocation can directly lead to hepatic inflammation, and have linked gut microbial signatures, dysbiosis, and translocation to liver disease in PLWH. Additionally, multiple trials have explored interventions targeting the microbiome in PLWH. Emerging research supports the interaction between the gut microbiome and liver disease in PLWH. This offers new opportunities to expand our understanding of the pathophysiology of liver disease in this population, as well as to explore possible clinical interventions.

审查目的:慢性肝病是艾滋病病毒感染者(PLWH)发病和死亡的主要原因。新出现的数据表明,肠道微生物转位可能在驱动和调节肝脏疾病方面发挥作用,这种双向关系被称为肠道-肝脏轴。虽然人们认识到 PLWH 存在严重的菌群失调和肠道微生物转位,但对 PLWH 的肠道-肝脏轴却知之甚少:最近的研究表明,微生物易位可直接导致肝脏炎症,并将 PLWH 的肠道微生物特征、菌群失调和易位与肝脏疾病联系起来。此外,多项试验还探索了针对 PLWH 微生物群的干预措施。新近的研究证实,在 PLWH 患者中,肠道微生物组与肝病之间存在相互作用。这为我们进一步了解该人群肝病的病理生理学以及探索可能的临床干预措施提供了新的机遇。
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引用次数: 0
Implementing Geospatial Science and Technology to Get to Zero New HIV Infections. 利用地理空间科学技术实现艾滋病毒零新增感染。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00658-w
Enbal Shacham, Stephen E Scroggins, Matthew Ellis

Purpose of review: Tremendous advancements have been made in HIV treatment and prevention during the last 40 years that zero new HIV cases has become an attainable goal declared by international agencies. However, new cases of HIV infection persist.

Recent findings: The emerging field of geospatial science is positioned to play key role in the reduction of continued HIV incidence through technology-driven interventions and innovative research that gives insights into at-risk populations. As these methods become more utilized, findings consistently show the important role of location and environment plays in HIV incidence and treatment adherence. This includes distance to HIV provider, locations of where HIV transmissions occurs compared to where people with HIV reside, and how geospatial technology has been leveraged to identify unique insights among varying groups of those at increased risk for HIV, among others. Given these insights, leveraging geospatial technology would play a prominent role in achieving zero new cases of HIV infections.

审查目的:在过去40年里,艾滋病毒治疗和预防取得了巨大进展,零新发艾滋病毒病例已成为国际机构宣布的可实现的目标。然而,新的艾滋病毒感染病例持续存在。最新发现:地理空间科学这一新兴领域将通过技术驱动的干预措施和深入了解高危人群的创新研究,在降低艾滋病毒持续发病率方面发挥关键作用。随着这些方法得到越来越多的应用,研究结果一致表明,地点和环境在艾滋病毒发病率和治疗依从性中起着重要作用。这包括与艾滋病毒提供者的距离,与艾滋病毒感染者居住的地方相比,艾滋病毒传播发生的地点,以及如何利用地理空间技术来确定艾滋病毒感染风险增加的不同群体的独特见解等。鉴于这些见解,利用地理空间技术将在实现零艾滋病毒感染新病例方面发挥重要作用。
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引用次数: 0
Reporting Individual-Level Research Results from Neurocognitive and Psychological Research in People Living with HIV: Lessons from Dementia Research. 报告艾滋病毒感染者神经认知和心理研究的个体水平研究结果:来自痴呆症研究的经验教训。
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00650-4
Holly L Peay, Stuart Rennie, Gail E Henderson

Purpose of review: There are growing expectations for the return of individual-level research results (RoR), which promotes autonomy and potential clinical and personal benefits. There are ethical and practical challenges, however, that may be exacerbated in research that assesses neurocognitive and psychological outcomes, including HIV-associated neurocognitive disorder (HAND). This paper reviews central concepts for RoR and recent empirical and conceptual articles from Alzheimer's disorder (AD) as a model for HIV.

Recent findings: Data from AD studies indicate high participant interest and low risk of harm from RoR, though additional research is needed. Investigators report a range of benefits, potential risks, and feasibility concerns. Standardized, evidence-based approaches are needed for RoR. For HIV research, we recommend a default position of offering RoR for cognitive and psychological outcomes. Investigators should justify decisions not to return results after assessing the potential value and feasibility of RoR. Longitudinal research is needed for feasible and evidence-based best practices.

综述目的:人们对个体水平研究结果(RoR)的回报期望越来越高,这促进了自主性和潜在的临床和个人利益。然而,在评估神经认知和心理结果的研究中,包括艾滋病毒相关的神经认知障碍(HAND),可能会加剧伦理和实践方面的挑战。本文回顾了RoR的核心概念以及最近阿尔茨海默病(AD)作为HIV模型的经验和概念性文章。最近的发现:来自AD研究的数据表明,参与者的兴趣高,RoR的危害风险低,尽管还需要进一步的研究。研究者报告了一系列的益处、潜在风险和可行性问题。RoR需要标准化的、基于证据的方法。对于艾滋病毒研究,我们建议默认为认知和心理结果提供RoR。在评估RoR的潜在价值和可行性后,研究者应该为不返回结果的决定辩护。需要进行纵向研究以确定可行的、以证据为基础的最佳做法。
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引用次数: 0
Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations. 与跨性别科学家、利益相关者和跨性别领导的社区组织一起制定社区参与实施战略。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 Epub Date: 2023-04-04 DOI: 10.1007/s11904-023-00656-y
Arjee Restar, Brian J Minalga, Ma Irene Quilantang, Tyler Adamson, Emerson Dusic, Leigh-Ann van der Merwe, Greg Millet, Danvic Rosadiño, Tanya Laguing, Elle Lett, Avery Everhart, Gregory Phillips, Rena Janamnuaysook, Pich Seekaew, Kellan Baker, Florence Ashley, Jeffrey Wickersham, Stephaun E Wallace, Don Operario, Kristi E Gamarel

Purpose of review: Pre-exposure prophylaxis (PrEP) represents one of the most effective methods of prevention for HIV, but remains inequitable, leaving many transgender and nonbinary (trans) individuals unable to benefit from this resource. Deploying community-engaged PrEP implementation strategies for trans populations will be crucial for ending the HIV epidemic.

Recent findings: While most PrEP studies have progressed in addressing pertinent research questions about gender-affirming care and PrEP at the biomedical and clinical levels, research on how to best implement gender-affirming PrEP systems at the social, community, and structural levels remains outstanding. The science of community-engaged implementation to build gender-affirming PrEP systems must be more fully developed. Most published PrEP studies with trans people report on outcomes rather than processes, leaving out important lessons learned about how to design, integrate, and implement PrEP in tandem with gender-affirming care. The expertise of trans scientists, stakeholders, and trans-led community organizations is essential to building gender-affirming PrEP systems.

综述目的:暴露前预防(PrEP)是预防艾滋病毒最有效的方法之一,但仍然不公平,使许多跨性别和非二元(跨性别)个体无法从这一资源中受益。针对跨性别人群部署社区参与的PrEP实施战略对于结束艾滋病毒流行至关重要。最近的发现:尽管大多数PrEP研究在生物医学和临床层面解决了有关性别确认护理和PrEP的相关研究问题,但关于如何在社会、社区和结构层面最好地实施性别确认PrEP系统的研究仍然悬而未决。必须更加充分地发展社区参与实施的科学,以建立确认性别的PrEP系统。大多数已发表的针对跨性别者的PrEP研究报告的是结果,而不是过程,忽略了关于如何设计、整合和实施PrEP以及性别确认护理的重要经验教训。跨性别科学家、利益相关者和跨性别领导的社区组织的专业知识对于建立性别确认的PrEP系统至关重要。
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引用次数: 0
Biological Aging in People Living with HIV on Successful Antiretroviral Therapy: Do They Age Faster? 成功接受抗逆转录病毒治疗的艾滋病毒感染者的生物衰老:他们衰老得更快吗?
IF 4.6 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-04-01 DOI: 10.1007/s11904-023-00646-0
Sara Svensson Akusjärvi, Ujjwal Neogi

Purpose of review: In the absence of a prophylactic/therapeutic vaccine or cure, the most amazing achievement in the battle against HIV was the discovery of effective, well-tolerated combination antiretroviral therapy (cART). The primary research question remains whether PLWH on prolonged successful therapy has accelerated, premature, or accentuated biological aging. In this review, we discuss the current understanding of the immunometabolic profile in PLWH, potentially associated with biological aging, and a better understanding of the mechanisms and temporal dynamics of biological aging in PLWH.

Recent findings: Biological aging, defined by the epigenetic alterations analyzed by the DNA methylation pattern, has been reported in PLWH with cART that points towards epigenetic age acceleration. The hastened development of specific clinical geriatric syndromes like cardiovascular diseases, metabolic syndrome, cancers, liver diseases, neurocognitive diseases, persistent low-grade inflammation, and a shift toward glutamate metabolism in PLWH may potentiate a metabolic profile at-risk for accelerated aging.

综述目的:在缺乏预防性/治疗性疫苗或治愈方法的情况下,抗击艾滋病毒的最惊人成就是发现了有效且耐受性良好的抗逆转录病毒联合疗法(cART)。主要的研究问题仍然是长期成功治疗的PLWH是否会加速、过早或加剧生物衰老。在这篇综述中,我们讨论了目前对PLWH中可能与生物衰老相关的免疫代谢谱的理解,并更好地了解PLWH中生物衰老的机制和时间动态。最近的发现:生物衰老,由DNA甲基化模式分析的表观遗传改变定义,已经在PLWH与cART中报道,指出表观遗传年龄加速。特定临床老年综合征的加速发展,如心血管疾病、代谢综合征、癌症、肝脏疾病、神经认知疾病、持续的低度炎症,以及PLWH向谷氨酸代谢的转变,可能会增加加速衰老的代谢风险。
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引用次数: 2
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Current HIV/AIDS Reports
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